EPA NON-FACULTY
ANNUAL PERFORMANCE REVIEW FORM
INSTRUCTIONS
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University policy requires that each EPA Non-Faculty employee receive a written annual performance evaluation for work
performed each fiscal year (July 1 through June 30).
This review should be delivered and discussed with the employee no later than June 30 of each year.
Supervisors may use this template or a template/memorandum of their own design.
For employees who have been in their present position less than 90 days as of June 30, the supervisor may choose either to
complete an interim review at the 90-day mark or to wait until the end of the next performance cycle.
REVIEW TYPE:
Interim
Annual
REVIEW CYCLE:
From:
Dept. Name:
Employee Name:
Dept. #:
Employee PID:
Supervisor Name:
Position Title:
Supervisor Title:
Date of Review with Employee:
ORGANIZATIONAL VALUES
1.
Position #:
RATING
QUALITY OF WORK:
a. Produces work that is accurate, thorough, and demonstrates sufficient analysis and
decision-making to meet the requirements of the employee’s position and profession.
b. Errors are infrequent, are recognized prior to completion of project, and/or are corrected
as soon as identified with little to no disruption of service.
c.
To:
Exceeds Expectations
Satisfactory
Needs Improvement
Not Satisfactory
Makes efficient and appropriate use of materials resulting in sufficient cost effectiveness
and little to no waste of resources.
d. Adheres to requirements for recordkeeping and documentation of work in a manner
readily understandable to others and sufficient for effective use by self and others.
COMMENTS ON PERFORMANCE IN THIS CATEGORY
2.
TASK MANAGEMENT:
a. Completes required volume of work by established deadlines.
b. Sufficiently prioritizes tasks and organizes work flows. Adapts to work changes and reprioritizes appropriately.
c.
Exceeds Expectations
Satisfactory
Needs Improvement
Not Satisfactory
Provides sufficient updates to supervisor and other relevant parties on the status of
assigned work. Appropriately escalates work concerns to management when warranted.
d. Does not require an excessive degree of oversight or correction. Does not place an undue
burden on supervisor or colleagues to complete assigned tasks.
COMMENTS ON PERFORMANCE IN THIS CATEGORY
(Rev. 07-01-2014)
Equal Opportunity Employer
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EPA NON-FACULTY
ANNUAL PERFORMANCE REVIEW FORM
Dept. Name:
Employee Name:
Dept. #:
Employee PID:
3.
CUSTOMER-ORIENTED COMMUNICATION:
a. Clearly and accurately conveys information in a manner suitable for the target audience.
b. Actively listens to determine the most effective way to address customer needs and
concerns.
c.
Position #:
Exceeds Expectations
Satisfactory
Needs Improvement
Not Satisfactory
Maintains a professional and respectful tone and exhibits diplomacy when dealing with
sensitive or confrontational situations.
d. Behavior, gestures, and speech present a positive image of the University to customers.
COMMENTS ON PERFORMANCE IN THIS CATEGORY
4.
TEAMWORK & COLLEGIALITY:
a. Communicates and engages directly, clearly, and tactfully with colleagues and
demonstrates respect for diversity and differing points of view among colleagues.
b. Shares knowledge and resources to reach common goals. Provides feedback and healthy
dialogue on performance and operational issues, as requested. Willingly adapts to change
and adheres to decided actions.
c.
Exceeds Expectations
Satisfactory
Needs Improvement
Not Satisfactory
Maintains a professional personal appearance and contributes equitably to maintaining
the workplace appearance.
d. Honors commitments, adheres to workplace rules, and performs additional duties when
team members are absent, during times of increased workload, or as otherwise requested
by management to meet business needs.
e. Stays productive and focused on assigned tasks during assigned work hours and maintains
a sufficient level of accessibility when away from the office to minimize impact on
operational needs.
COMMENTS ON PERFORMANCE IN THIS CATEGORY
5.
POLICY & SAFETY COMPLIANCE:
a. Complies with University personnel policies, including adherence to prohibitions on
harassment, discrimination, and workplace violence, and protection of confidentiality of
personnel records for employees, students, research subjects, patients, and others as
required.
Exceeds Expectations
Satisfactory
Needs Improvement
Not Satisfactory
b. Complies with departmental policies and procedures, as well as trade standards, industry
protocols, state and federal regulations, and the professional ethics associated with the
position.
(Rev. 07-01-2014)
Equal Opportunity Employer
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EPA NON-FACULTY
ANNUAL PERFORMANCE REVIEW FORM
Dept. Name:
Employee Name:
Dept. #:
Employee PID:
c.
Position #:
Complies with all University safety requirements for the position, including training,
medical clearance, use of personal protective equipment, and injuries/illness reporting and
medical treatment.
d. Complies with all other University policies, including IT security protocols and appropriate
use of University information technology, property, and financial resources.
COMMENTS ON PERFORMANCE IN THIS CATEGORY
6.
SUPERVISION (IF APPLICABLE):
a. Provides adequate stewardship of assigned resources, including budget, space, equipment,
and staffing.
b. Plans and communicates unit goals and objectives. Provides clear and reasonable direction
regarding assigned duties. Distributes work appropriately within unit.
c.
Exceeds Expectations
Satisfactory
Needs Improvement
Not Satisfactory
Provides candid, timely, and constructive feedback on performance and behavior.
Applies appropriate corrective action as warranted. Attends to employee development.
d. Serves as role model. Engenders trust, commitment, and civility. Fosters respect for
diversity within work unit. Responsive to feedback from subordinates and others.
COMMENTS ON PERFORMANCE IN THIS CATEGORY
OVERALL RATING (required for Annual Review only)
NOT SATISFACTORY
NEEDS IMPROVEMENT
SATISFACTORY
EXCEEDS EXPECTATIONS
OVERALL COMMENTS FOR PERFORMANCE CYCLE
(Rev. 07-01-2014)
Equal Opportunity Employer
Page 3 of 4
EPA NON-FACULTY
ANNUAL PERFORMANCE REVIEW FORM
Dept. Name:
Employee Name:
Dept. #:
Employee PID:
Position #:
CORRECTIVE ACTION PLAN (required for all ratings of not satisfactory or needs improvement)
PERFORMANCE GOALS FOR THE NEXT PERFORMANCE CYCLE
SIGNATURES FOR PERFORMANCE REVIEW
2nd-Level Supervisor:
(optional)
Date:
Supervisor:
Date:
I acknowledge that I have received this performance review. I understand that my signature below does not necessarily imply agreement with
the ratings given or the comments included, and that if I choose, I may write a response to include with this appraisal document.
Employee:
(Rev. 07-01-2014)
Date:
Equal Opportunity Employer
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